Lung Cancer |

Primary Pulmonary Leiomyosarcoma With Cardiac Metastases FREE TO VIEW

Nagendra Madisi, MBBS; Kenneth Miller, MD
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Internal Medicine, Johns Hopkins/Sinai Hospital, Silver Spring, MD

Chest. 2014;146(4_MeetingAbstracts):671A. doi:10.1378/chest.1995279
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SESSION TITLE: Cancer Student/Resident Case Report Posters III

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Primary pulmonary leiomyosarcomas (PPPLS) are exceptionally rare tumors and constitute only 0.2-0.5% of the total lung cancers. Sarcomas metastasizing to brain or heart are rare and PPPLS, with metastases to both have never been reported to our knowledge . Here, we present a case of high-grade PPPLS with brain and cardiac metastases.

CASE PRESENTATION: A 69-year old man with a history of smoking and emphysema, presented with complaints of productive cough of blood-tinged phlegm. Physical examination was normal except for crackles at lung bases. Chest radiograph revealed a new 8 centimeter right lower lobe opacification. A thoracic CT confirmed a mass and bilateral hilar and mediastinal lymphadenopathy. A PET scan demonstrated avid FDG uptake in the mass but not in the lymph nodes or elsewhere in the body. These were new findings when compared to a chest X-ray and thoracic CT one year prior to presentation.Pathology from a percutaneous core needle biopsy of the lung mass revealed high grade PPPLS. One month later an elective right lower lobe lobectomy was performed with negative resection margins and negative lymph nodes and chemotherapy was begun. Two months later he was readmitted with word finding difficulties, right-sided facial droop and weakness. Brain imaging revealed a 4.6 x 4.5 x 4.9 centimeter mass in the left fronto-parietal region with significant surrounding edema. Subsequently, resection of the cerebral metastasis was performed. Pathology revealed high grade sarcoma noted to be morphologically similar to previously resected lung mass. Neurologic symptoms improved postoperatively but PET scan showed cardiac metastases anterior to the left atrium and inferior to the right main pulmonary artery, which were new compared to echocardiography 2 months prior. Subsequently he requested hospice care and died due to local recurrence and extensive metastases.

DISCUSSION: A review of the literature revealed 2 published case reports of PPPLS with metastasis to the brain but none to the heart. Cardiac metastases are often asymptomatic and echocardiography is better than CT for diagnosing cardiac metastases. Coronary occlusion or compression from tumorous masses can lead to myocardial infarction, eventual heart failure, and death are the complications. Radiation and anticoagulation therapy should be considered given the highly life threatening nature of cardiac metastases and the possibility of soft tissue dissemination(1)(2).

CONCLUSIONS: This case adds to the literature, describing a novel case. It also emphasizes the importance of early evaluation of patients with soft tissue sarcomas for cardiac metastases and prompt treatment to avoid adverse side affects. Larger studies are required to define best practice guidelines.

Reference #1: Takenaka S et al. Eleven Cases of Cardiac Metastases from Soft Tissue Sarcomas. Jpn J Clin Oncol. 2011;414: 514-8

Reference #2: Hallahan DE et al. Cardiac Metastases from Soft Tissue Sarcomas.J Clin Oncol. 1986;4:1662-9.

DISCLOSURE: The following authors have nothing to disclose: Nagendra Madisi, Kenneth Miller

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